Recommedations for Management of Neonatal Purpura Fulminans | Website Bệnh viện nhi đồng 2 - www.benhviennhi.org.vn

Timing of default from tuberculosis treatment: a systematic review Margaret E. Kruk 1 , Nina R. Schwalbe 2 and Christine A. Aguiar 1 1 Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA 2 Global Alliance for TB Drug Development, TB Alliance, New York, NY, USA Summary objectives To provide a systematic assessment of the timing of default from tuberculosis (TB) treatment which could help to quantify the potential contribution of new shorter duration TB drugs to global TB control. methods We performed a systematic review following QUOROM guidelines. MEDLINE was searched from 1998 to the present using the terms TB and default or drop-out or compliance or adherence and therapy. A total of 840 articles were returned. A further detailed manual review selected 15 randomized trials and observational studies that reported timing of drop-out and focused on developing countries. results The selected studies comprised randomized controlled trials, retrospective record reviews, and qualitative assessments and spanned 10 countries. Both directly observed treatment (DOT) and non-DOT programs were represented. Thus results were highly heterogeneous and not statistically aggregated. Data suggest, but do not conclude, that the majority of defaulters across the studies completed the 2-month intensive phase of treatment. conclusions There is insufficient high-quality comparable information on the timing of default from TB treatment to permit any firm conclusions on trends in default. However, a substantial pro- portion of defaulters appear to leave treatment in the later stages of the current 6-month regimen, suggesting that new TB chemotherapeutic agents which can reduce the length of treatment have the potential to improve global TB treatment success rates. keywords tuberculosis therapy, directly observed treatment, default, time of default, temporal trends Introduction Tuberculosis (TB) is a global health emergency, killing nearly 1.6 million people each year, mostly in low- and middle-income countries (Stop-TB Partnership 2006). TB cases in Africa have more than quadrupled since 1990, as a result of co-infection with HIV (WHO 2005). The World Health Organization (WHO) – recommended treatment strategy, directly observed treatment or direct observation (DOT), which forms the basis of the Stop TB Strategy, is a 6- to 8-month regimen with a combination of anti-TB agents (Lienhardt & Ogden 2004). This regimen is also known as short-course chemotherapy (SCC). The first 2 months of SCC, known as the intensive phase, generally involve a combination of four drugs and the 4- to 6-month follow-up period, known as the continuation phase, involves two drugs. Both the drugs used in treatment and the duration of the intensive phase may vary within SCC programs. While cure rates with this combination under optimal conditions approach 95%, actual global treatment success in 2005 was 84% (Borgdorff et al. 2002; WHO 2007). This figure is much lower in some regions: In Africa, the overall cure rate for smear-positive TB was 74% and as low as 54% in some areas (WHO 2007.) Further, Mycobacterium tuberculosis resistant to both isoniazid and rifampicin, or multi-drug resistant TB, is now diagnosed in an estimated 4.3% of all new and previously treated TB patients (Zignol et al. 2006). A major contributor to both treatment failure and the rise of multidrug-resistant TB is inadequate and incomplete treatment (Borgdorff et al. 2002; Sharma & Mohan 2006). While structural factors such as interruptions in drug supply play a role, patient default ESPGHAN Committee on Recommedations for Management of Neonatal Purpura Fulminans Hematology and Oncology Department Children Hospital Neonatal Purpura Fulminans Protein C Protein S Antithrombin INACTIVATE Protein C deficiency Protein S deficiency Antithrombin deficiency Factor Va Factor VIIIa REDUCE Thrombin generation HYPERCOAGULABLE STATE Neonatal Purpura Fulminans Typical skin lesions of neonatal purpura fulminans Neonatal Purpura Fulminans Extensive full thickness necrosis of skin Initial treatment • Fresh Frozen Plasma • Protein C concentrate Fresh Frozen Plasma • Class I, level A • Administration of 10 – 20 mL/kg of FFP every 12 hours until the clinical lesions resolve (Antithrombotic Therapy in Neonates and Children Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Guidelines) Protein C concentrate • Class I, level A • Administration of 20 – 60 units/kg of protein C concentrate every – hours until the clinical lesions resolve (Antithrombotic Therapy in Neonates and Children Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Guidelines) Long-term management • • • • Oral anticoagulation therapy Low molecular weight heparin Protein C concentrate Liver transplantation Low molecular weight heparin • Class I, Level C • Subcutaneous administration every 12 hours • 1.7 mg/kg in term infants, mg/kg in preterm infants • Goal: [anti-aFX] = 0.5 – IU/ml • Prophylaxis: 0.8 - mg/kg • Goal: [anti-aFX] = 0.1 – 0.3 IU/ml (Viviana Bacciedoni et al Thrombosis in newborn infants, Arch Argent Pediatr 2016;114(2):159-166) (Antithrombotic Therapy in Neonates and Children Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Guidelines) Warfarin • Class I, Level C • 0.2 - 0.3 mg/kg/d • Goal: INR 2.5 – 4.5 (Viviana Bacciedoni et al Thrombosis in newborn infants, Arch Argent Pediatr 2016;114(2):159-166) (Antithrombotic Therapy in Neonates and Children Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Guidelines) Protein C replacement • Class I, Level B • 30 - 50 units/kg every - days • Intravenous or subcutaneous (V.E.Price et al Seminar in Fetal and Neonatal Medicine, Elsevier 2011: 1-5) (Antithrombotic Therapy in Neonates and Children Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Guidelines) Protein C replacement Liver transplantation • Class I, Level C • Definitive cure (Antithrombotic Therapy in Neonates and Children Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Guidelines) Thrombolytic therapy • Life-, organ-, limb-threatening condition • Not enough evidence for use in Neonatal Purpura Fulminans Recommendations and level of evidence for treatment of NPF ent Class I Benefit >>> Risk Should be performed Level A Multiple (3 – 5) population risk strada evaluated FFP Protein C concentrate Level B Limited (2 -3) population risk strada evaluated Protein C longterm Level C Very limited (1 -2) population risk strada evaluated LMWH Warfarin Liver transplantation Class IIA Benefit >> Risk Reasonable to performe Class IIB Benefit ≥ Risk May be considered Class III Risk ≥ Becifit Not helpful May be harmful Thank for your attention! ORIGINAL RESEARCH Open AccessEmergency intraosseous access in a helicopteremergency medical service: a retrospective studyGeir A Sunde1,2*, Bård E Heradstveit1,2, Bjarne H Vikenes1,2, Jon K Heltne1,2,3AbstractBackground: Intraosseous access (IO) is a method for providing vascular access in out-of-hospital resuscitation ofcritically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseoustechniques have been used by our Helicopter Emergency Medical Services (HEMS) since 2003. Few articlesdocument IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in pre-hospital emergency situations handled by our HEMS.Methods: We reviewed all medical records from the period May 2003 to April 2010, and compared three differenttechniques: Bone Injection Gun (B.I.G® - Waismed), manual bone marrow aspiration needle (Inter V - Medical DeviceTechnologies) and EZ-IO® (Vidacare), used on both adults and paediatric patients.Results: During this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO®. Rates of success onfirst attempt were significantly higher using the EZ-IO® compared to the manual needle/Bone Injection Gun (p <0.01/p < 0.001). Fifteen failures were due to insertion-related problems (19.2%), with four technical problems (5.1%)and three extravasations (3.8%) being the most frequent causes. Intraosseous access was primarily used inconnection with 53 patients in cardiac arrest (75.7%), including traumatic arrest, drowning and SIDS. Otherdiagnoses were seven patients with multi-trauma (10.0%), five with seizures/epilepsy (7.1%), three with respiratoryfailure (4.3%) and two others (2.9%). Nearly one third of all insertions (n = 22) were made in patients younger thantwo years. No cases of osteomyelitis or other serious complications were documented on the follow-up.Conclusions: Newer intraosseous techniques may enable faster and more reliable vascular access, and this canlower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believethat all emergency services that handle critically ill or injured paediatric and adult patients should be familiar withintraosseous techniques.BackgroundVascular access is important in the resuscitation of criti-cally ill or injured adult and paediatric patients [1,2]. Itcan be challenging to obtain vascular access, especiallyin the resuscitation of small children in emergencysituations [3-5]. The European Resuscitation Council2005 guidelines [6] and International Liaison Committeeon Resuscitation guidelines [4] recommend intraosseousaccess during resuscitation if intravenous access provesto be difficult or impossible. Despite these recommenda-tions, intraosseous techniques appear to be rarely used[7]. While numerous reports have been published aboutthe use of different intraosseous devices in emergencypatients, they are primarily from paramedic-basedambulance services [2,8]. Few comparisons have beenpublished of different IO techniques used by physiciansin emergency departments [7] or in HEMS servicesmanned by physicians/nurses [9,10].Typical HEMS operating conditions make specialdemands on medical equipment such as IO devices.Rain, cold, darkness and non-sterile conditions meanthat such equipment must be durable and simple to usein all conditions. User friendliness is important for res-cuers, both on-scene and in-flight [10].Intravenous access is traditionally regarded as theoptimal route for medication and fluids, and the* Oral Ondansetron for Gastroenteritis in a Pediatric Emergency Department Background BỘ GIÁO DỤC VÀ ĐÀO TẠO TRƯỜNG ĐẠI HỌC DÂN LẬP HẢI PHÒNG ------------------------------- ISO 9001 : 2008 KHÓA LUẬN TỐT NGHIỆP NGÀNH: NGOẠI NGỮ HẢI PHÒNG - 2010 2 HAIPHONG PRIVATE UNIVESITY FOREIGN LANGUAGES DEPARTMENT ----------------------------------- GRADUATION PAPER A STUDY ON TRANSLATION OF ENGLISH - RELATED TERMS IN FINANCE AND BANKING INTO VIETNAMESE By: BUI THI THOM Class: NA 1004 Supervisor: DAO THI LAN HUONG, M.A HAI PHONG - 2010 3 BỘ GIÁO DỤC VÀ ĐÀO TẠO TRƯỜNG ĐẠI HỌC DÂN LẬP HẢI PHÒNG -------------------------------------- Nhiệm vụ đề tài tốt nghiệp Sinh viên: .Mã Số: Lớp: Ngành: Tên đề tài: . . 4 Nhiệm vụ đề tài 1. Nội dung và các yêu cầu cần giải quyết trong nhiệm vụ đề tài tốt nghiệp ( về lý luận, thực tiễn, các số liệu cần tính toán và các bản vẽ). …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… 2. Các số liệu cần thiết để thiết kế, tính toán. …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… Update on mangement of patent ductus arteriosus in preterm infants Dr Trinh Thi Thu Ha Outline Overview of PDA Timing of screening PDA? When to treat PDA? Timing of ductal closure Prenatal MgSO4, tocolytic Postnatal surfactant  Early, severe pulmonary hemorrhage is associated with ductal patency at 12 to 18 hours of age, but later pulmonary hemorrhage (after the first week) is not related to persistent ductal patency (Workbook in Practical Neonatology 5th Edition 2015)  Diagnosis: In most cases, the clinically silent PDA during the first few days goes undetected unless an echocardiogram is performed  Signs of bounding pulses, active precordium, and systolic murmur were of reasonable specificity but very low sensitivity in the first to days of birth for diagnosis of an echocardiographically defined significant PDA  Relying on clinical signs alone led to a mean diagnostic delay of days (A blinded comparison of clinical and echocardiographic evaluation of the preterm infant for patent ductus arteriosus.Skelton R1, Evans N, Smythe J JPaediatr Child Health 1994 Oct;30(5):406-11) Ibuprofen Prophylaxis  No significant differences in mortality, IVH, or BPD  No reduction in IVH, PAL in the treated group  Increased risk of gastrointestinal bleeding  Prophylactic ibuprofen exposes many infants to renal and gastrointestinal side effects without any important short-term benefits and is not recommended Pre-symptomatic Pharmacologic Treatment  No effect on the rate of mortality, BPD, IVH, ROP, or length of ventilation, death, IVH, NEC,…  More renal side effect  Presymptomatic indomethacin or ibuprofen therapy for PDA in preterm infants is not recommended Conservative Management       Fluid restriction Diuretics, avoidance of loop diuretics Maintaining a hematocrit of 35 to 40 percent Increased positive airway pressure Correction of alkalosis Avoidance of pulmonary vasodilators: oxygen or NO  Asymptomatic infants with PDAs generally not require medical management or surgical ligation These infants should be monitored for evidence of CHF, failure or renal TREES OF THE NORTHERN UNITED STATES THEIR STUDY, DESCRIPTION AND DETERMINATION FOR THE USE OF SCHOOLS AND PRIVATE STUDENTS BY AUSTIN C. APGAR PROFESSOR OF BOTANY IN THE NEW JERSEY STATE NORMAL SCHOOL "Trees are God's Architecture."—Anonymous. "A Student who has learned to observe and describe so simple a matter as the form of a leaf has gained a power which will be of lifetime value, whatever may be his sphere of professional employment."—Wm. North Rice. NEW YORK-:-CINCINNATI-:-CHICAGO AMERICAN BOOK COMPANY Copyright, 1892, by the AMERICAN BOOK COMPANY. W. P. 3. [Pg 3] PREFACE. This book has been prepared with the idea that teachers generally would be glad to introduce into their classes work dealing with the real objects of nature, provided the work chosen were of a character that would admit of its being studied at all seasons and in all localities, and that the subject were one of general interest, and one that could be taught successfully by those who have had no regular scientific instruction. The trees of our forests, lawns, yards, orchards, streets, borders, and parks give us just such a department. Though many consider a large part of the vegetable kingdom of little importance, and unworthy of any serious study, there are few who do not admire, and fewer still who do not desire to know, our trees, the monarchs of all living things. The difficulty in tree study by the aid of the usual botanies lies mainly in the fact that in using them the first essential parts to be examined are the blossoms and their organs. These remain on the trees a very short time, are often entirely unnoticed on account of their small size or obscure color, and are usually inaccessible even if seen. In this book the leaves, the wood, the bark, and, in an elementary way, the fruit are the parts to which the attention is directed; these all can be found and studied throughout the greater part of the year, and are just the parts that must be thoroughly known by all who wish to learn to recognize trees. Though every teacher is at liberty to use the book as he thinks best, the author, who has been a class teacher for over twenty years, is of the opinion that but little of Part I. need be[Pg 4] thoroughly studied and recited, with the exception of Chapter III. on leaves. The object of this chapter is not to have the definitions recited (the recitation of definitions in school work is often useless or worse than useless), but to teach the pupil to use the terms properly and to make them a portion of his vocabulary. The figures on pages 38-43 are designed for class description, and for the application of botanical words. The first time the chapter is studied the figure illustrating the term should be pointed out by the pupil; then, as a review of the whole chapter, the student should be required to give a full description of each leaf. After this work with Chapter III., and the careful reading of the whole of Part I., the pupils can begin the description of trees, and, as the botanical words are needed, search can be made for them under the proper heads or in the Glossary. The Keys are for Children ‘s Hospital – Gastrointestinal Department OVERVIEW HISTORY Fluoroquinolones are highly active in vitro against both Gram (-) RETRACTILE TESTES A review of the current literature UROLOGY DEPARTMENT CHILDREN’S HOSPITAL NO.2 Definitions  Normal size  Intermittently resides in the groin  Testes that can be brought down into their normal position in the scrotum  Remains there for a period Aetiology  Variant of normal  Strong scremasteric reflex  Taut spermatic cord in a testis which is in the process of ascending Clinical examination  Supine  Manipulate the testis to the base of the scrotum  Release to observe whether it remains there or moves back up into the groin OUTCOME OF RETRACTILE TESTES  Acquired undescended testes  Acute torsion  Reduced fertility  Tumour risk Acquired undescended testes  La Scala & Ein reviewed 150 boys with 205 retractile testes with a 7year follow-up period  23% of retractile testes eventually becoming an acquired UDT [1]  Agarwal et al a cohort of 122 boys with 204 retractile testes over years of follow-up: 32% of retractile testes eventually becoming acquired UDT [2]  cord tautness as a risk for ascent  Stec et al looked at the outcome of 172 boys with 274 retractile testes over a follow-up period of 26 months  7% acquired UDT [3]  Limited: definition, indication of orchidopexy, short follow-up periods Acute torsion  Only an isolated case report of this within the literature (Charles JC The fate of the retractile testis J Urol 2004;171:1237) [4]  Retractile testes are no increased risk for acute torsion over normal testes Tumour risk  Congenital UDT have an increased relative risk of germ cell malignancy that may be approximately 5-10 times [5]  Acquired UDT not have an increased risk of malignancy [6]   retractile testis per se is not at an increased relative risk of developing a cancer Reduced fertility  Caucci et al sperm counts in semen of 38 young male adults treated for retractile testes before puberty and adults with retractile testes  normal semen analysis: 21% in young adults with previously treated retractile testes, 29% in adults with retractile testes  retractile testes with reduced size are a risk factor for male infertility [9]  Other epidemiological studies of infertile adult males have identified retractile testes as being associated with lower sperm counts and hypospermatogenesis on biopsy[10-12]  increase in testicular temperature resulting in impaired spermatogenesis [12] Reduced fertility  Puri and Nixon assessed paternity rates in 43 adult males who as children had bilateral retractile testes: 74% of the subjects had fathered children and that testicular volumes were normal  retractile testes develop normally with no harmful effects on fertility [13]  Dadfar MR performed orchidopexies on 22 adult males with idiopathic infertility and bilateral retractile testes, and measured their testicular volumes and sperm parameters after year: no change in testicular volume and sperm density, but improved sperm motility [14]  Limited: not established paternity, not performed semen analysis Conclusion  Retractile testis may become an ascended testis: Level evidence  Acute torsion: no evidence  Tumour risk: no evidence  Reduced fertility: poor evidence  Not enough evidence to warrant orchidopexy on a retractile testis  But recommend annual clinical surveillance of retractile testes until beyond puberty  And reserve orchidopexy for testes which can no longer be brought down into the scrotum (ascended testes) Thank for your attention! References [1] La Scala GC, Ein SH ... generation HYPERCOAGULABLE STATE Neonatal Purpura Fulminans Typical skin lesions of neonatal purpura fulminans Neonatal Purpura Fulminans Extensive full thickness necrosis of skin Initial treatment... Therapy and Prevention of Thrombosis, 9th ed: ACCP Guidelines) Thrombolytic therapy • Life-, organ-, limb-threatening condition • Not enough evidence for use in Neonatal Purpura Fulminans Recommendations... Pediatr 20 16;114 (2) :15 9-1 66) (Antithrombotic Therapy in Neonates and Children Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Guidelines) Warfarin • Class I, Level C • 0 .2 - 0.3